November 11, 2008

By: Dr BalaSivakadadcham – Canada

Historical Background:

‘Agastiar’ and ‘Thirumoolar’ are two names often associated with the origin and development of medical art in Tamil Nadu and SriLanka. Agastiar is said to be a north Indian scholar who migrated to the South many hundred years ago, not only mastered the Tamil language and but also wrote the first book on Tamil grammar. Agastiar is also claimed to be the sage who introduced Ayurveda to the people of Tamil Nadu. Inspite of these widely prevalent traditions there is no single text either on grammar or on medicine in Tamil that could be attributed to sage Agastiar.

Thirumoolar, on the other hand, has actually written a book on Hindu philosophy in Tamil in which he insists the importance of maintaining health and prolonging the length of one’s own lifetime on this earth in order to find the truth of existence. Surprisingly, traditions also attribute a north Indian origin to Thriumoolar who came to the South from Kashmir to meet Agastiar but forced to live here under extraordinary circumstances. There is little doubt that the ayurvedic system of medicine had been already in place and was being practiced widely in Tamil Nadu at the time when the author of ‘Silappathikaram’ wrote his epic poem. In his description of one of the ancient cities of Tamil Nadu, the author, Ilango Adigal, mentions the dwellings of astrologers and Ayurvedic physicians in the city. Most Tamil literary scholars believe that Silappadikaram was probably written around the 1st century A.D.

After being introduced to the people of Tamil Nadu by scholars from North India, Ayurveda had its own course of development in the South. South Indian scholars made many valuable contributions to the Ayurvedic system of medicine and these contributions were acknowledged by the compilers of later medical texts and adopted by medical practitioners all over India.

Before beginning to discuss the development of Ayurvedic system of medicine in Tamil Nadu and Srilanka, let us look at some of the traditions associated with the origin of Ayurveda in North India.

Traditions attribute a divine origin to Ayurveda. Sanskrit traditions quote Atri as the rishi through whom Ayurveda was revealed to this world by Brahma, the grand seer of the universe. From Atri, the knowledge was passed on to his descendants called Atreyas. One of his descendants, Punarvasu, was the teacher who instructed the author of one of the most ancient texts on Ayurveda available today. The lectures of Punarvasu were written down separately by each of his six students, Agnivesa, Bhela, Harita, Jatukarna, Parasara, and Kaarapani. Caraka, the author of the oldest existing book on Ayurveda, acknowledges at the end of each chapter of his book that his is a revision of the treatise of Agnivesa, a student of Atreya Punarvasu. Caraka was the court physician of Kaniska who ruled the Kushan empire in north India in the 1st century A.D. Atreya Punarvasu’s lectures have thus survived for more than two thousand years in the book that we know today as ‘Caraka Samhita’.

The next oldest textbook on Ayurveda is Susruta Samhita. Susruta, the author of this book acknowledges Dhanvantari as the source of the matter contained in his book. Dhanvantari is identified by some scholars with Divodasa, a ruler of Kasi (Benares) in the vedic age. It is claimed that the celestial physician made his appearance in this world as a king of Kasi and imparted his knowledge to his disciples one of whom was Susruta. A Sinhalese medical work Vaidya Cintamani Baisadya Sangraha claims that Ayurveda was first revealed to scholars like Punarvasu and Dhanvantari by Shakraya, the king of the heaven, who perceived it from Brahma, the supreme God. Whitlow Ainslie, who studied Tamil medicine in India in the early 19th century, mentions another Singhalese tradition, which claims that Aswini Devas, the divine physicians, instructed Ayurveda to Dhanvantari and others. Although these traditions quote different divine personalities in accordance with their own religious beliefs, they all agree in the divine origin of Ayurveda. Giving Ayurveda a sacred origin and placing it among the holiest religious texts or Vedas, the priestly caste in India succeeded in guarding this valuable information from being leaked out to the ordinary people and to the outside world for a considerable period of time.

” The science of life should be studied by Brahmans, Kshatriyas and Vaisyas. Brahmans should learn it for doing good to all creatures; Kshatriyas should learn it for self preservation;. Vaisyas should learn it for gain. In general, all should study for the acquisition of religious merit, wealth and pleasure.
Caraka Samhita; Sutrasthana; Lesson XXX.

Although Caraka does not restrict the study and practice of medicine to one particular caste, it is evident that Sudras, the lowest class in the society, were not permitted to have access to the ancient medical texts like Caraka Samhita considered sacred. As a result, Brahmins dominated the medical profession for a considerable period of time. Surgery, however, has never been the subject of Brahmins. Since surgery involved touching and dissecting of the diseased body, this field was considered unsuitable for the priestly caste. The ancient medical text revised and rewritten by Caraka gives little information regarding surgery. When dealing with diseases that require surgical aid Caraka may be seen to refer the reader to surgeons. On the other hand, Susruta,, while classifying Ayurveda into eight main branches, treats surgery as the principal subject in his book.

Ancient Indian medical practitioners were thus divided into two categories, the Kayachikitsikas (Physicians) who were mostly Brahmins and Salyachikitsikas (surgeons) who were non-Brahmins. In course of time, however, medical profession as a whole was considered unsuitable for the Brahmins. Brahmins who practiced medicine were grouped into a sub-caste known as Vaidyas. The study and practice of Ayurvedic medicine, like every other occupation in India, came to be confined to this particular caste. Eventually, anyone who took up medical profession came to be known as a Vaidya. Even then, the physicians but not the surgeons were entitled for this designation.

The Royal Surgeons:

There is evidence to believe that in ancient days surgery was patronized and practiced by those of the warrior caste, the Kshatriyas. Even the kings showed a keen interest in learning and practicing the art of surgery. Dhanvantari, the authority on surgery, is believed to be none other than Divodasa, the king of Kasi (Varanasi) and his pupil, Susruta is claimed to be the son of Viswamitra, a rishi from the Kshatriya caste). The Pali chronicle Mahavamsa highlights the surgical skills of the king Buddhadasa (337 - 365 A.D) quoting many of his extra-ordinary achievements in this field. Segarajasekaram, a Tamil medical work compiled in Jaffna during the reign of an Ariyachakravarti (Circa 1500 A. D.), claims that the king, Segarajasekaran made use of the bodies of the enemies who died in battle to study human anatomy.

The keen interest shown by Kshatriyas in surgery could be attributed to their basic duties as a warrior caste. The wars resulted in the loss of limbs and wounds. Surgical aid was imminent in such cases. Even during the time of Chandragupta (325 - 301 B. C.), the grandfather of king Asoka, an ambulance unit equipped with surgeons and nurses accompanied the army marching to the battlefield.

The interest shown by the ancient kings in surgery gradually faded away and surgery came to be looked upon as an ignoble profession. This change of attitude towards surgical treatment is attributed to the emergence and influence of religions (Buddhism and Jainism) that preached against war and violence. Consequently surgery was handed over to some members of the lowest class in the society. Surgeons during this time neither enjoyed a respectable status nor received an adequate remuneration. Eleventh century inscription found in Tamil Nadu reveals that the person who performed surgery (salyakriya) in the Vira cholan Atura Salai, a hospital named after king Viracholan, was paid much lower wages than what was paid for the physician or the apothecary attached to the same hospital. Eventually, surgery was taken over by a still lower category of the society, the hairdressers.

In the early days, hairdressers were assisting surgeons in certain tasks such as shaving the hair of the patient prior to surgery. Because of this association with the surgeons, the hairdressers probably had gained some knowledge of minor surgical operations. They were also known for their ability to use sharp instruments on sensitive parts of the human body. These credentials gave them some recognition and confidence when they were asked upon to perform some surgical operations. Even today, the villagers in Jaffna (SriLanka) address the hairdresser as ‘Parihari’ (the person who treats). It is interesting to note that in Europe, in 1163 A.D., when Christian priests were barred by the papal decree from taking up any profession that involves bloodletting, surgery was handed over to the hairdressers. In England, during the time of Edward the fourth (1462 A.D), surgeons union was amalgamated with the hairdressers union. Only in 1745 A.D, these two associations were separated. However, Royal college of Surgeons was not recognized until 1800 A.D. Until recently, only Physicians were given the title ‘Doctor’ but the surgeons.